A case for cannabis legalisation

Prohibition has made criminal syndicates rich and little else. The legalisation of cannabis will drive quality and variety, further blurring the lines between medicinal and recreational use.

On 17 April 2018, the Leader of the Australian Greens, Senator Dr Richard Di Natale, launched a drug reform campaign aimed at legalising recreational cannabis use for all Australian adults. The Greens propose creating a tightly regulated cannabis market, overseen by a new statutory body:

The Australian Cannabis Agency would be established to issue licenses for cannabis production and sale, act as the single wholesaler of legally accessible cannabis, carry out a program of monitoring and enforcement of premises of production and sale, and conduct ongoing review and monitoring of the regulatory scheme to ensure it is functioning optimally.

We would also establish retail stores to sell cannabis. These stores would require ID to enter and ban sales to anyone under the age of 18, sell only plain packaged cannabis (with visible health warnings) and require staff to undertake a responsible sale of cannabis course.

Growth of six plants at home for personal use would be permitted, but strict penalties would apply for unlicensed or underage sales, or driving whilst under the influence of cannabis.

The Greens argument, which I strongly support, is that prohibition has failed:

Criminalisation of the production and use of cannabis has caused multiple harms, including forcing people to live with criminal records for possessing only a small amount of weed, pushing cannabis users to purchase from drug dealers and consume a product of unknown strength and quality, and diverting money into the futile law enforcement response and away from drug and mental health treatment and education.

Federal Health Minister, The Hon. Greg Hunt MP came out and called for the Greens to dump the policy, stating that cannabis is ‘a gateway drug’ to methamphetamine and heroin use.

Dr Alex Wodak AM,  president of the Australian Drug Law Reform Foundation and one of the most respected AoD researchers in the country, argues that ‘cannabis taxation and regulation is an idea whose time has come’. He says that, ‘like the debate about same sex marriage, the idea will seem strange to some in advance but once the reform has been completed we will wonder why it took us so long.’

Dr Wodak provides a brief history lesson to show that the decision to ban cannabis in the 1920s was, at the very least, devoid of evidence. ‘There was no careful root and branch review of the evidence. Instead, Australia was represented at a League of Nations meeting in Geneva in 1925 where delegates from several countries decried the dangers of cannabis.’ Dr Wodak cites Robert Kendell in his 2003 article Cannabis Condemned:

“A claim by the Egyptian delegation that [cannabis] was as dangerous as opium, and should therefore be subject to the same international controls, was supported by several other countries. No formal evidence was produced and conference delegates had not been briefed about cannabis.”

Dr Wodak remarks:

Accordingly, the Commonwealth wrote to the states after the meeting instructing them to prohibit cannabis. This is the quicksand upon which the mighty edifice of cannabis prohibition in Australia was constructed.

From an international perspective, the Greens’ state-controlled proposal is similar to the model adopted by Uruguay in 2014, in which Uruguay legalised growing up to six plants at home, as well as the formation of growing clubs, a state-controlled dispensary regime, and the creation of a cannabis regulatory body.

By comparison, Colorado in the United States legalised the sale and possession of cannabis for non-medical uses in 2012, including private cultivation of up to six  plants, with no more than three being in flower at the one time. Colorado established a commercial market for consumers aged 21 years and over, as well as regulations for the commercial cultivation, manufacture, and sale similar to alcohol, for recreational use.

The prohibition effect: limited knowledge, quality and variety. Rich bikers.

Australian consumers’ knowledge of cannabis has been shaped by their experience of prohibition and is, in general, unsophisticated by international standards. Many Australians have experienced cannabis smoked through a bong with tobacco or rolled into a joint. Combustion, however, is only one way in which people consume cannabis products. Some Australians may have eaten decarboxylated cannabis in a cake or brownie. Comparatively few know that cannabis can be vaporised or used in concentrated forms such as dabs. Along with edible products, personal vaporisers have emerged as a preferred method of delivery for medicinal cannabis patients because there is no evidence they adversely affect the respiratory system.

The average Australian cannabis consumer might distinguish between two types of cannabis: ‘hydro’, a catch-all term describing high-potency, indoor-grown hydroponic cannabis that can sometimes have a strong chemical odour and taste; and, ‘outdoor’ or ‘bush weed’, which is more commonly found outside of the major city centres. This is a false dichotomy.

In communities where both cannabis markets and consumer knowledge is more advanced, consumers choose between sativa dominant or indica dominant strains. These categories relate directly to the two major species, Cannabis sativa and Cannabis indica. A third species,  Cannabis ruderalis, is mainly used to breed autoflowering hybrids because of its unique ability to flower without a photoperiod cue.

Cannabis plants produce a unique mix of terpeno-phenolic compounds called cannabinoids. There are over 100 different cannabinoids that have been isolated from the plant, including the two most prevalent: the psychoactive delta-9 tetrahydrocannabinol (THC), and cannabidiol (CBD). CBD is not considered psychoactive and is being offered by doctors in the United States for its ability to reduce nausea and anxiety, among other things.*

In jurisdictions where medical cannabis is legal, dispensaries fill prescriptions for specific strains of cannabis – for example, strains that stimulate the appetite and suppress pain, or relieve anxiety and stress. Medicine Man, a family-run business in Denver offers over 40 different medicinal and recreational strains, all varying in THC/CBD content and ratio, with wildly different terpene profiles.

Differentiation between medicinal and recreational strains is relatively arbitrary: popular medicinal strains such as G-14, Liberty Haze, Super Sour Diesel, Jamaican Lion and Girl Scout Cookies are equally, if not more, popular with recreational consumers.

Dispensaries offer strains specifically bred to taste of citrus, tropical fruits such as mango, berries, pine and even cheese. These plants are bred for particular concentrations of naturally occuring terpenes in their flowers. The four most common terpenes found in cannabis are Myrcene (found in hops, mangoes, lemongrass, citrus, thyme and bay leaves), Pinene (found in conifers and some citrus), Limonene (found in citrus rind, rosemary and peppermint) and Linalool (found in mint, bay leaves, lavender and cinnamon).

In Australia, most of the hydroponic cannabis bought on the streets is produced by criminal syndicates, predominantly outlaw motorcycle gangs. These producers favour fast growing, high-yielding, high-THC strains with next to no CBD content.

The chemical taste associated with ‘hydro’ is caused by producers pumping as many nutrients into the flowering plants as they can to maximise their yield per watt of electricity used. Outlaw motorcycle gangs are not known for their subtlety. They do not take the extra week needed to ‘flush’ their plants with fresh water prior to harvest, which leads to the excess nutrients remaining in the plant’s flowers and leaves producing an unpleasant taste. It is this high-potency, foul-tasting, low-medicinal-value product that most Australian cannabis consumers are introduced to, often by the same people selling methamphetamine, pills of dubious consistency masquerading as MDMA, prescription drugs (Xanax and Oxycontin) and heroin.

Competitive markets drive quality and variety in produce. Uncompetitive markets, such as bikie oligopolies, do not. Cannabis prohibition in Australia has succeeded in enriching organised crime and little else.

Jimmy

‘Jimmy’s a good kid’, scrawls my handwriting under a brown tea stain, ‘looks after his mum and little sister, working a shit job for worse pay. He always seems to be down on his luck’.

I met Jimmy in 2008 while I was doing ethnographic research in a New South Wales country town. As luck would have it, Jimmy and I also crossed paths in an alcohol rehab several years later in another country town about six hours drive inland.

Jimmy went to juvie in his teens after committing a bunch of minor misdemeanours culminating in significant time away from his family. His last crime was purchasing and being caught by the cops with a quarter ounce bag of cannabis.

Jimmy didn’t go back to school after juvie. When I met up with him years later, Jimmy was a shell of what he once was. He had broken both legs in a car accident and had become hooked on opioid painkillers, washed down with whatever was on special at the bottle shop. Jimmy was in rehab as a circuit-breaker for his ongoing legal and family problems. Still, we shared old stories and some laughs; hit the weights together and snuck cigarettes at the AA meetings.

Jimmy took his own life later that year.

Rachel

When I met Rachel she was 29, trying to establish her own small business. Rachel smoked bongs, which she believed helped her anxiety. She refused to take the new antidepressants prescribed by her doctor because she said her first prescription didn’t help her anxiety at all and caused what the pharmaceutical companies call ‘discontinuation symptoms’ when she stopped taking them. Rachel said that these symptoms, including vertigo, severe headaches, nausea and heavy sweating, left her in a constant state of panic and made it impossible for her to leave the house for a week.

Rachel preferred to grow her own bush weed because she was terrified of the people who deal hydro. When she was younger, living for a while in Redfern, she was scoring  from some guys in the Cross. One night, they asked her to come to a pub for a drink. She woke up many hours later looking down the barrel of a video camera documenting her rape by multiple assailants.

Gateways and other hyperbole

Minister Hunt’s response to the Green’s policy proposal is unfortunately characteristic of much of modern Australian politics which appeals to emotion first and intellect a distant second. Hyperbole works only when people do not question the underlying assumptions being proposed.

It is true that cannabis prohibition can be a gateway to other drug use precisely because it forces consumers onto the black market. Consider Rachel’s horrific experience of having the date rape drug, Rohypnol, slipped in her drink by her dealer. Or consider that Jimmy maintained his opioid addiction long after his doctor stopped prescribing him Oxycontin because he already had access to a black market network.

The majority of people who use cannabis do not go on to use other, so-called ‘harder’ substances that are physically addictive (including alcohol, which is legal). In the United States, the 2014 National Household Survey on Drug Use and Health found less than half of Americans aged over 12 had tried cannabis, while less than 15 percent had used cocaine and less than 2 percent had used heroin. In general, only 10 to 20 percent of those who try alcohol and other drugs get hooked.

While cannabis may cause cross-sensitisation to other drugs, alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like cannabis, also regularly used prior to a person progressing to other, more harmful substances.

There is a growing body of research supporting an ‘anti-gateway’ hypothesis, which proposes that cannabis use can provide a way out for people suffering from physical addictions to alcohol, and other recreational and prescription drugs. One recent study surveyed medical marijuana users in Canada,  and found that 87 percent of participants used it to replace alcohol, prescription opioids or other recreational drugs. 52 percent reported that cannabis helped them reduce alcohol use, while 80 percent reported using less prescription pain medications.

Final word

As medical cannabis reform gathers pace there will be increasing pressure on the government to open up its very restrictive regime to a wide variety of medical conditions. Indeed, the line between medical and recreational use is arbitrary, and does not reflect the reality of how people consume cannabis: most self medicate with the same substance they use for recreation.

If we turn to the the potential benefits, legalisation in Australia would reduce the costs of drug enforcement, taking the pressure off police, courts and prisons, and customs. It would limit the income of black market cannabis suppliers, including outlaw motorcycle gangs, and would raise substantial revenue through tax receipts at a time when the Commonwealth is struggling for tax revenue. Lastly, legalisation would create a functioning market in Australia, providing quality and variety, and a safe way for consumers to purchase their drug of choice.

NOTE: Names have been changed to maintain confidentiality.

 

*Caroline A. MacCallum and Ethan B. Russo,  ‘Review Article: Practical considerations in medical cannabis administration and dosing’, European Journal of Internal Medicine, 2018, 49: 12-19. Available for free: http://www.ejinme.com/article/S0953-6205(18)30004-9/pdf

In the latest edition of the European Journal of Internal Medicine, researchers argue that the ‘legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such [cannabis-based] treatment. With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable.’ As a correction, they provide the most up to date data on cannabis pharmacology, methods of administration (smoking, vaporisation, oral), and dosing recommendations. Suggestions are offered on cannabis-drug interactions, patient monitoring, and standards of care, while special cases for cannabis therapeutics are addressed: epilepsy, cancer palliation and primary treatment, chronic pain, use in the elderly, Parkinson disease, paediatrics, with concomitant opioids, and in relation to driving and hazardous activities.